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Appeals Nurse/RN Case Manager-Appeals and Denials

Company: Westchester Medical Center
Location: Valhalla
Posted on: June 9, 2021

Job Description:

Assistant Utilization Coordinator - Denials/ Appeals Department

Summary: Under general supervision, an incumbent of this class assists in the implementation or investigation of the procedures specified in the Quality Management, Utilization Review and Discharge Planning Program at Westchester Medical Center specifically related to insurance denials and subsequent appeals processes. Depending upon assignment, incumbents may implement the review/screening aspects of the Quality Improvement Plan; monitor the length of stay and resource consumption of patients; evaluate, develop procedures to improve patient care; assist in carrying out all aspects of the Quality Improvement Program to ensure that Westchester Medical Center continues to meet the medical standards for patient care prescribed by accrediting, licensing and reimbursement agencies. Supervision may be exercised over a small number of the support staff. Does related work as required.

Licensure: Possession of a valid license and current registration, issued by the New York State Department of Education, as a registered professional nurse.

Training and Experience: and three years of experience where the primary function of the position was nursing in a hospital or health care agency, one of which must have been at a leadership level, and one year of which must have been in either a hospital, health care agency or managed care company in the area of utilization review, quality assurance, risk management or discharge planning.

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Keywords: Westchester Medical Center, Yonkers , Appeals Nurse/RN Case Manager-Appeals and Denials, Other , Valhalla, New York

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